Health authorities in Uzbekistan felt obliged recently to deny the existence of any order on the forced sterilization of women, saying surgical contraception is performed only as a last resort and only at the patient's request.

The move was a response to recent claims in Central Asia's most populous nation that physicians were secretly being pressured by the government to perform such operations.

It's still unclear whether officials have in fact pushed for such drastic medical procedures, as a regional information website and some rights activists insist. But Uzbek health authorities are clearly eager to curb pregnancies among some categories of women -- including younger women and those beyond their mid-30s -- and they acknowledge that "social and economic factors" play a role in which women are advised to undergo hysterectomies, for instance.

"We're not saying that forced sterilization is taking place," says Suhrob Ismoilov of the Expert Working Group, a Tashkent-based nonprofit that brings together civil-society groups issues of the public interest. "However, in some places women are being tricked into such surgery."

Some observers say that whether fact or fiction, fears of forced sterilization have reached the point that women are avoiding routine medical checkups and others are opting for home birth so they don't have to face the kind of scrutiny that could lead to unwarranted hysterectomies.

Power Of Persuasion

The sterilization controversy erupted shortly after the Uzbek Health Ministry issued a decree, known simply as Decree No. 40, in mid-February. The order describes hysterectomies as a safe and effective form of contraception if performed properly and orders provincial health officials to offer voluntary surgical contraception at hospitals. The order also states that hysterectomies, which involve the partial removal of the uterus, should be conducted only by experienced physicians, free of charge, and with the consent of the patient.

A report issued two weeks later by ferghana.ru and backed by rights activists, however, claimed that the Health Ministry had "secretly ordered every doctor to secretly sterilize two women per month." The initiative, according to the website, was aimed at curbing population growth in the poverty-stricken nation of 28 million.

Rights observers recalled that Uzbekistan had been accused of using forced contraception as part of a population-control campaign in 1999-2003, and said there was some evidence that certain women were currently being "duped" into agreeing to hysterectomies.

A March 10 response by the Health Ministry to the ferghana.ru report says "voluntary sterilization or voluntary surgical contraception (VSC) was offered by doctors to only those women who are contraindicative to other methods of contraception," according to Bishkek-based Central Asian News. ...Or Free Advice?

In an interview with RFE/RL's Uzbek Service, a health official from Tashkent Province speaking on condition of anonymity indicates that women of certain social categories are more apt to receive advice on contraception.

"There are many women who already have four or five kids, and they can't afford to get pregnant again for health and social-economic reasons," she says. In an effort to educate women on how to avoid pregnancy, the official adds, "We recommend to them various contraceptive methods, including the surgical procedure."

"No one is trying to reduce birthrates. They say that ailing women and young women like 17-to-19-year-olds should not have children," the official says.

She warns that "there should be a certain interval" of at least three years between each pregnancy, adding that "women over 35 years old should not get pregnant."

"Only these categories are being targeted," the official says.

She says 57 percent of women in the province that includes the capital, Tashkent, "suffer from anemia or other diseases" that could be complicated by pregnancy. The official goes on to criticize early marriages and early pregnancies, saying that "17-to-19-year-old girls have to study."

She cites 20 cases in that province over the past year of girls as young as 15 becoming pregnant, and stresses that health institutions promote the "optimum age of 20-30" for childbearing.

"According to our information, in some places, such as the Karakalpakistan Autonomic Republic and the city of Tashkent, local health authorities have issued their own decrees and worked out their own sterilization regulations," complains the Expert Working Group's Ismoilov. "Under such regulations, health workers were given an instruction to persuade at least two women each month to undergo voluntary sterilization."

Fear And Doubt

Haitboy Yokubov the head of human rights group Najot in northwestern Khoresm Province, says women there have expressed concerns that they were improperly led to believe they needed hysterectomies.

"We have spoken to 17 women in Khiva district -- some of them had undergone [hysterectomies], others were relatives of those who have had the procedure," Yokubov says. "The women said that when they visited medical institutions, they were told, 'You have a dangerous gynecological disease. To prevent its development, we need to perform an operation.' That's how many women underwent the surgery."

Following the surgeries, Yokubov explains, the women began to have doubts. But they had no official recourse to pursue their concerns.

"There were even cases in which people complained to local health authorities," Yokubov says. "Authorities prevented some women from going to courts."

A young woman from Khoresm whose sister recently had a hysterectomy tells RFE/RL's Uzbek Service on condition of anonymity that birth-control measures are being imposed on women against their will, or at least without their knowledge.

"In Khoresm, women over 35 years old are being forced to wear an intrauterine device after they give birth," the woman says. "Sometimes doctors [perform hysterectomies] to prevent them from getting pregnant again. Doctors visit neighborhoods and send women for compulsory screenings. 'We will close your uterus free of charge,' they say."